Beth Macy has been a newspaper reporter in the Roanoke, Virginia area for three decades. In this book, she provides extensive reporting on the opioid crisis, how it developed and wreaked havoc in Appalachia, and how it grew into a national crisis across the United States.

“Dopesick” is the colloquial term people who are addicted and addiction medicine specialists use to describe the constellation of wrenching and violent symptoms opioid withdrawal causes. As one of Macy’s subjects describes it:

You’re throwing up.You have diarrhea. You ache so bad and you’re so irritable that you can’t stand to be touched. Your legs shake so bad you can’t sleep. You’re as ill as one hornet could ever be. And believe me, you’ll do anything to make the pain go away.” (p. 41)

As a result, not long after a person is addicted to opioids, drug seeking behaviors are not motivated by the urge for the next and best high, but instead are driven “to avoid dopesickness at any cost” (p. 9). Macy divides her reporting into three major parts: 1) the ways Purdue Pharma fueled the explosion of opioid addiction beginning with the introduction of its product Oxycontin in 1996; 2) the ways in which people get addicted to opioids and how they get their supplies; and 3) the ways the U.S. health care system, criminal justice system, Congress, state legislatures, and regulatory agencies have failed in preventing and fixing the addiction crisis. As a journalist, Macy weaves the stories of individuals into the larger story of the opioid addiction crisis: people who became addicted to opioids and the effect it had on their families, and the stories of health care professionals who pulled alarms about the rapidly rising rate of opioid addiction and tried as best they could to treat addicted patients and protect the public. We read about the Purdue Pharma executives who were blamed and prosecuted for the marketing campaigns that turned localized opioid addiction patterns into a national opioid addiction epidemic. And we read about individual sheriffs, investigators, prosecutors, judges, and community activists who were trying to stem the tide of addition and death. These stories intersect throughout the book.

Embedded among the individual story lines are digressions Macy uses to elaborate on certain aspects of the opioid addiction crisis. She provides historical perspectives on drug addiction, and how this crisis differs from those of the past. She puts an emphasis on how trends in medical practice to liberalize the use of opioids in the management of all types of pain—minor and major, acute and chronic—converged with Purdue Pharma marketing campaigns for its proprietary opioid products. She cites statistics to show how fast the epidemic was worsening, how widely it was spreading across the United States, and how deadly it had become with mortality rates exceeding those of AIDs mortality at its peak. Other digressions cover how illicit opioid supply chains are created and maintained, and how different levels of governments reacted to the crisis.

The narrator tracks a hypothetical week in the life and work
of a psychiatrist in a major Canadian hospital through the stories of
individual patients, some of whom were willing to be identified by name.

The book opens with “they are us” and the shocking discovery
that a patient whose life has been ruined by mental illness is a medical school
classmate.

Other patients have been followed for many years—a woman
with eating disorder, a man with bipolar disease, another with schizophrenia. A
new patient with intractable depression finally agrees to electroshock therapy,
and the first treatment is described. The painful duty of making an involuntary
admission pales in contrast to the devastation of losing a patient to suicide.
Goldbloom’s personal life, opinions, and worries are woven throughout with
frank honesty. His mother’s metastatic brain tumor sparks the associated
intimations of his own advancing age and mortality. His genuine fascination with and appreciation of
the effective modalities now available are matched by his frustration over how
they are beyond reach of far too many because of the stigma that is still
attached to mental illness and the lack of resources and political will to make
them available.

A family epic set in rural Mississippi and spanning several generations. Often described as a road novel by reviewers, the story centers on Jojo, a 13-year-old boy struggling to protect his younger sister Kayla from the disarray of his parents' influence: one Black, one White; one in prison; both addicted to meth. These forces contend with Jojo's stoic yet caring grandfather, his mystical-spiritual grandmother, his bigoted grandparents on the other side, and the strange passenger they collect while on the road.

Subtitled "A Memoir of Mental Interiors," this book is both an exploration of self and a search for reasons that led to the suicide of the author's friend, Henry, when both were of college age. But there is more. As the memoir unfolds, we learn that since childhood, the author experienced episodes of inexplicable, preoccupying, repetitive thoughts and behavior patterns--much later diagnosed as obsessive compulsive disorder (OCD). And finally, Barber discusses being drawn to work with mentally retarded people in a group home, and the mentally ill homeless at Bellevue Hospital in New York City.Growing up in an intellectual New England family with a tradition of sending its sons to Andover (a prestigious prep school) and Harvard, Barber was expected to continue the tradition, and so he did. At Harvard, however, Barber found himself disintegrating into obsessive thinking, unable to concentrate, near suicidal. He withdrew from Harvard, went back to his small town, hung out with his friends Henry and Nick, washed dishes in a local restaurant, took courses at the local college. Obsessive thinking continued to torment him.In desperation, he dropped out of college again, quickly finding a position as a "childcare worker" in a local group home. The author believes this step was the turning point that led eventually to effective treatment of his OCD (psychotherapy and Prozac), completion of his education, a fulfilling "career" in mental health recovery, and a happy family life. He is currently an associate of the Yale Program for Recovery and Community Health at Yale University School of Medicine.

James Rhodes is a British classical concert pianist who is known
for his iconoclastic, pop-inspired performing style. He is also an outspoken survivor of childhood
sexual abuse who is equally frank about his struggles with severe mental
illness. Rhodes’s memoir Instrumental
is a tribute to the healing power of music.
Indeed, music quite literally saves the author’s life; it is only when a
friend smuggles an iPod loaded with Bach into his psych ward that Rhodes
regains the will to live.

Rhodes does not mince words.
We learn that he was violently raped by a gym teacher on a regular basis
for five years from the age of five. Left with severe internal injuries that
produce wracking pain, he requires multiple surgeries. He soon also develops dissociative symptoms, drug
and alcohol addiction, self-injurious behaviors, and chronic suicidal ideation.
Barely able to function, he endures many tumultuous years during which he abandons
the piano. The author’s subsequent journey
from physical and emotional fragmentation to wholeness through music provides
the substance of his book.

The preface to Instrumental
is designated “Prelude,” and the ensuing twenty chapters, labeled “tracks,” all
correspond to musical works. (All twenty
tracks may be listened to, for free, on Spotify.) In addition, as if to assure
the reader he is in good company, Rhodes offers psychological profiles of famous
composers. We learn, for example, that Bruckner
suffered from a morbid obsession with numbers, and that Schumann, after
throwing himself in the Rhine, died in an asylum.

This film focuses on the interaction between 5-year-old Alexandria and Roy, a Hollywood stuntman in the early days of film. The two are residents of a rehabilitation hospital, and both are recovering from falls they’ve taken: he’s paralyzed from the waist down as a result of a failed stunt; she’s broken her humerus as the result of a fall she’s taken in an orange orchard. (A child in a migrant family, she’s been tasked, at 5 years of age—presumably out of economic necessity—with climbing ladders to pick oranges.) Having accidentally intercepted an affectionate note—Alexandria’s child-missive—meant for the kindly but preoccupied nurse Evelyn, paralyzed Roy befriends the girl and quickly wins her over by telling her the wondrous tale of a masked bandit and his companions, all of whom have been betrayed by the evil emperor Odious, and all of whom are united in their quest for vengeance against the ruler. While Roy narrates the story, we see it take place through Alexandria’s eyes, and the characters she envisions are drawn from people in her life. The role of the heroic masked bandit she assigns to Roy himself, blended to a poignant degree with her deceased father. Alexandria sometimes interrupts and asks questions about or challenges the story’s development, whereupon Roy makes adjustments: it’s clear that the story is a co-constructed project. Roy has, however, become increasingly despondent over his paralyzed condition and over the fact that his fiancée has broken off the engagement as a result of Roy’s condition. As time goes on, Roy uses his unfolding story as a means of manipulating Alexandria to retrieve morphine from the hospital dispensary. He tries and fails to commit suicide with the pills that Alexandria supplies. In the process, he winds up bringing about a severe injury to the child. Filled with remorse and guilt, Roy alters his story such that it can be a source of separation between him and the girl: it becomes cruel and violent, and suggests that the hero is a weak, inglorious imposter who deserves to die. The anguished Alexandria protests, demanding that Roy change the story. Roy refuses, insisting that “It’s my story.” But Alexandria retorts, “It’s mine, too.” And Roy relents. The masked bandit of the story is redeemed, and Roy himself is as well. The film closes first with Roy, Alexandria, the hospital patients and staff watching the film in which Roy’s acting had led to his accident. As the scene approaches the point where the accident had occurred, Roy feels understandable anxiety; but the film has of course been edited. Roy is relieved, but turns to Alexandria, in the hopes that she is not terrified. He finds her beaming. Then the film we are watching, The Fall, shifts to a rapid series of black-and-white footage of stunts—the effect is reminiscent of the love scenes gathered at the end of Cinema Paradiso—narrated by the marveling Alexandria. Each clip features a person in imminent, catastrophic danger—who is then impossibly rescued at the last second by fortunate chance. As Alexandria blows us kisses through a character who is falling backward, we are left in a state of bewildered gratitude over this strange gift of stories we human beings offer each other—stories that assure us over and over again how, confronted with the calamities we see no way of escaping, we are nonetheless saved.

The Knick was inspired by the Knickerbocker
Hospital, founded in Harlem in 1862 to serve the poor. In
this 20-part TV series spread out over two seasons, the fictional Knick is somewhere in the lower half of
Manhattan around 1900. The time covered during the series is
not marked in any distinct way. The characters don’t age much, and although fashion
and customs remain static during the series, the scope and significance of
advancements that come into play were actually adopted over a longer time than the
episodes cover.

The
series builds on some known history. The central character, the chief surgeon Dr. John Thackery, is modeled on a famous surgeon of
the time, Dr. William Halsted, in both his surgical adventurism and in his drug
addictions. The character Dr. Algernon Edwards, who is an African-American,
Harvard-educated, and European-trained surgeon, is based in part on Dr. Louis
T. Wright, who became the first African-American surgeon at Harlem Hospital
during the first half of the 20th century.
Storylines
of human drama and folly run through the series. Among them are medical cases
both ordinary and bizarre, heroic successes and catastrophic failures, loves
won and lost, gilded lives and wretched existences, honor and corruption,
racism and more racism. Within and around these storylines are the scientific,
medical, and industrial advances of the period, as well as the social contexts
that form fin de siècle hospital care and
medical research in New York City.

Some
of the industrial advances we see adopted by the hospital include
electrification, telephone service, and electric-powered ambulances. We see
that transitions to these new technologies are not without risks and
catastrophes: patients and hospital staff are electrocuted, and when the ambulance batteries died -- a frequent occurrence-- many of the patients they carried died, too.Medical advances integrated into various
episodes include x-rays, electric-powered suction devices, and an inflatable
balloon for intrauterine compression to stop bleeding. Thackery is a driven
researcher taking on some of the big problems of the day, such as making blood
transfusions safe, curing syphilis, and discovering the physiologic mechanisms
of drug addiction. We see how he learns at the cost of his patients, or rather
his subjects. We also glimpse movements directed at population health.
For example, epidemiological methods are applied to find the source of a
typhoid outbreak, which drew from the actual case of Mary Mallon (aka, Typhoid
Mary). Shown juxtaposed to the advances epidemiology was then
promising is the concurrent interest that was rising in eugenics and its broad
application to control for unwanted groups. Research ethics and regulations
were a long way off.

The subtitle is
accurate enough: “A Memoir of a Family and Culture in Crisis,” although the
author J.D. Vance is, in fact, the focal point of view throughout, from his
childhood to his success as an adult. Few young people made it out of the hills to enjoy stable and successful
lives, but J.D. was one of them, earning a degree at Ohio State University,
then a law degree at Yale. While recounting his life, he also describes
his relatives and neighbors, and he interprets the many dilemmas of his
hillbilly culture.
Vance was born
in 1984 and grew up in Jackson, Kentucky, a poor town following the collapse of
coal mining. His family was beset with poverty, alcoholism, mental instability,
and more. His mother had nine miscarriages and suffered from addictions; she
had multiple husbands. The culture around him suffered from domestic violence,
drug abuse, hoarding, unemployment, honor defended by fists, knives, or guns, as
well as bad financial habits, bad diets, obesity, lack of exercise, sugary
drinks, dental problems, and what he calls “emotional poverty.” There was welfare abuse and, in general “a
chaotic life.” He credits his grandparents, other relatives,
various teachers and professors for supporting him, guiding him, and comforting
him when he was hurt, angry, and/or confused.

Like many other
hillbillies, J.D. moved some hundred miles north into southern Ohio, where
steel companies provided jobs—that is, until they closed, like many other employers
in the Rust Belt. There also, hillbillies were left without income and social
problems increased. Stores and restaurants closed. Payday lenders and
cash-for-gold shops took their place. Drug dealers and users took over empty
houses.

After high
school, Vance joined the Marines. He credits the military for teaching him discipline,
persistence, and for developing his self-respect. For his success at Yale, he
thanks his professors, his girlfriend (later wife), and classmates for helping
him understand customs of New England society. One example: he leaves a banquet
to call his girlfriend; she instructs him on how to handle the nine pieces of unfamiliar
silverware surrounding his plate.

The last three chapters (11, 12, 13) and the conclusion analyze
his experience on more conceptual terms, including the “social capital” prized by the the New
England world, social instability of the culture he was raised in, and “adverse
childhood experiences” (or ACEs), the psychologists’ phrase for the damaging
events children experience in a culture of poverty, violence, and
limited futures. He writes that governmental child services have policies that
don’t understand the important roles of aunts, uncles, and grandparents in subcultures that rely on extended families. Indeed, faithful to his mother, he, as an
adult, provides specific help to her.

The narrator Lucia works in a California city emergency room. Her job title is not specified - possibly a registration clerk or triage nurse. She enjoys working in the ER and marvels at the human body: "I am fascinated by two fingers in a baggie, a glittering switchblade all the way out of a lean pimp's back" (p90). Death, however, is a regular visitor.

All day, ambulances back up to the emergency room, gurneys rumble by, and charts accumulate. The staff is too busy. Patients are restless, frightened, and angry. She notes how everything associated with the ER appears gray - patient's skin, blankets, emergency vehicles. And perhaps the prognosis of patients as well: "Everything is reparable, or not" (p90).

Lucia describes Code Blues, the deaths of gypsies, an encounter with a blind man whose wife was DOA, drunks, and suicide attempts. She wonders why the elderly fall down so frequently. She's frustrated by the large number of people who come to the ER without an actual emergency and longs for "a good cut-and-dried stabbing or a gunshot wound" (p93). But Lucia worries that she has become too desensitized working in the emergency room, maybe even inhuman. Yet the flow of patients doesn't slow down - those with true life-threatening conditions and those who probably don't need to be there.

Samuel Shem's (Stephen Bergman) The House of God, first published in 1978, has sold over two million copies in over 50 countries (see annotation). Its 30th anniversary was marked by publication of Return to The House of God: Medical Resident Education 1978-2008, a collection of essays offering historical perspectives of residency education, philosophical perspectives, literary criticism, and women's perspectives, among others. Contributors include such well-known scholars as Kenneth Ludmerer, Howard Brody, and Anne Hudson Jones, as well as physician-writers Perri Klass, Abigal Zuger, Susan Onthank Mates, and Jack Coulehan. The closing section, "Comments from the House of Shem," includes an essay by psychologist and scholar Janet Surrey (Bergman's wife) and one by "both" Samuel Shem and Stephen Bergman.